Psychiatric medications, science, marketing, psychiatry in general, and occasionally clinical psychology. Questioning the role of key opinion leaders and the use of "science" to promote commercial ends rather than the needs of people with mental health concerns.

Thursday, November 08, 2007

I have pilloried the study published in the American Journal of Psychiatry in September 2007 that purported to show that fewer SSRI prescriptions for kids in the USA was associated with an increase in the youth suicide rate for American youth. I quote from my earlier post below:

Look closely at the above graphs (click to enlarge) from the article.Note that the decrease in SSRI prescriptions from 2003 to 2004 was very slight across the 0-10, 11-14, and 15-19 age groups, which is the timeframe in which suicide rates for those aged 5-19 increased notably.The larger declines in SSRI prescribing for youth occurred from 2004-2005, which happens to be when the suicide rate for those aged 15-24 appears to have decreased from 10.3 per 100,000 (see Table 9; page 28 here) to 9.8 per 100,000 (see Table 7 here).Yes, I know I am comparing data for ages 15-24 to data on ages 5-19, but I think this makes sense when one considers that the suicide rate for those 14 and under is much lower than for those aged 15-24.Actually, grouping suicide data for ages 5-19 makes little sense to me given the vast differences in suicide rate within this age group.

It is important to note that the authors of the paper did not have data from 2005, but there is nothing from the 2003-2004 U.S. SSRI prescription data cited in their paper that even suggests a relationship between decreased SSRI use in youth and an increased suicide rate, as the decrease in prescriptions was minimal.Pay close attention: The authors ran a total of zero statistical analyses to examine the relationship between SSRI prescription rates and suicide rates in the United States.That’s right, zero.So they put up a couple of figures without a single shred of statistical evidence, then claim that declining SSRI prescriptions are associated with an increase in suicide rates.Any peer reviewer who was not drunk or on a high dose of Seroquel should have noticed this gigantic flaw.

Various newspapersand websites dumbly ran with this story using descriptions such as:

Warnings that antidepressants may increase teen suicides appear to have backfired, a new study suggests...

Suicide rates for preteens and teenagers increased sharply when the Food and Drug Administration slapped a "black box" warning on anti-depressants and doctors started writing fewer prescriptions for young people, according to federal data released Thursday

Enter NIMH: In a story datelined September 19, 2007, Jules Asher wrote a story for the NIMH website. As of today, it is still available. It mentions that

...based on mathematical models using previous years' data, the authors predicted an 18 percent increase in youth suicides between 2003 and 2005.

And, as mentioned above, this prediction turned out to be incorrect. Youth suicide rates in 2005 showed little change from 2004. Perhaps the NIMH writing staff could throw that little tidbit of information into an updated version of the article? Earlier in the piece, it is mentioned that

NIMH grantees Robert Gibbons, Ph.D., University of Illinois at Chicago and J. John Mann, M.D., Columbia University, and colleagues, make a case for a possible link between changes in prescription patterns, regulatory warnings and suicide rates in the September, 2007 issue of the American Journal of Psychiatry.

Again, note that they did not make much of a case in that the only statistical analysis they presented was from the Netherlands, yet they apparently believe such data generalized to the US as well. And remember that their own graphs contradict their argument and that the 2005 preliminary data on suicides also contradicts their arguments. The reason I am ranting/raving here is because I expect better from an allegedly nonpartisan organization that is dedicated to science. Why publish a story on the NIMH website pushing results from a study that is so full of holes that I could drive a fleet of Mack Trucks through it? Did the NIMH run stories publicizing findings of more credible research showing a link between SSRIs and increased suicide attempts? Nope. Kind of makes one wonder to what extent NIMH is an objective organization dedicated solely to advancing science, doesn't it?

Major hat tip to an anonymous reader who passed along the link to this wonderful article.

5 comments:

No, to think that any agency that deals with the US Feds or the Big Corporatocracy is free of "politicization" these days would be asking to get run over by the Mack truck, wouldn't it?? Objectivity must needs take a back seat to PROFIT$ every time, eh?

Great post, as are so many that you put on here. Many thanks for this blog.

When it comes to antidepressants and suicide I have always heard that antidepressants make a person feel so much better that suddenly they have the energy to kill themselves, whereas before they were just too depressed to do so. This never made a lick of sense to me. Could it be that what the person is feeling from the antidepressant is agitation, and this is what spurs them to suicide? I just don't get the claim that okay now the person feels better so they're going to off themselves. If it is in fact true that the antidepressant makes a person feel so wonderful that now they have the energy to kill themselves, do we really want to bring a patient to that level of wellness? What is your opinion?

Clinical lore has long stated that suicide occurs once people start feeling better. However, the agitation angle and the disinhibition angle make more sense to me in relating suicide to antidepressants. Plus, if placebos help depressed people, on average, nearly as much as antidepressants, then wouldn't we expect a roughly equivalent rate of suicides on placebo in comparison to antidepressants?

Thanks for your comment, Lisa, and I also appreciate the nice feedback from lady broadoak.

Hey, thanks for responding to my question. It's a question I've had ever since sitting in a psychology class years ago, which is when I first heard the claim that people taking antidepressants end their lives when they start feeling better. It didn't make sense to me then, and I could never get anyone to produce any data to back up the claim. I always suspected it was more nervous energy/agitation that was the culprit, but then I don't have any supporting data, either. Anyway, thanks for responding.

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I'm an academic with a respectable amount of clinical experience and no drug industry funding. Given my lack of time, don't expect multiple daily updates. Certain things about clinical psychology, the drug industry, psychiatry, and academics drive me nuts, and you'll probably pick up on these pet peeves before long...